Patricia O. born
Patricia is a young
pregnant woman, living in a residence for migrant
mothers, run by the Town Hall of Rome. We meet her
after a psychomotor crisis during which she
assaulted a woman, hosted in the same place and we
therefore activated a compulsory treatment in the
psychiatric ward of S. Filippo Neri Hospital.
Patricia is not aware
of being seven months pregnant and after a month in
the psychiatric department she is transferred to
the gynecology department to deliver.
Due to her mental
confusion and severe relationship difficulties, a
nurse is constantly with her to prevent runaways or
assaults to other patients.
From now on our
integrated group focused on homeless with mental
problems, is involved in Patricia’s care process.
Through the hospital's social worker and other
operators of our group, we try to retrace Patricia’s
Patricia is totally
absorbed in her delirium of pregnancy denial and
when questioned about her story, she only answers
that she has been in Crotone where she has a home
and a partner.
In some occasions she
also provides some phone numbers but all the
attempts to call those failed.
At the end of
December 2016 Patricia gives birth to a child, but,
continuing the state of delusional denial, 10 days
after birth, the adoption process is activated.
As far as we
understand, she certainly landed in Lampedusa, where
she lived for about a month and was moved to a
refugees’ camp in Crotone. In our last meeting in a
cliinic where she is currently sheltered, for the
very first time she speaks about her husband, who is
maybe in prison, not even recalling his name.
During her staying
in Crotone, most likely Patricia entered in
prostitution and became pregnant; it seems like that
only through this condition she was able to seek
help from the institutions
health condition seems to be satisfying, but her
psychic state is very disturbed and a first
diagnosis of puerperal psychosis (ICD 10: F 53.1)
remains unchanged, even after childbirth.
A sharp relational
retreat is evident and contacts are only established
through continuous requests for concrete items.
Patricia sometimes steals small things, often for
female use, and above all, she is constantly asking
for money; in some cases she is available for sex,
for a few cents or some coffee.
The clinical course
of psychosis tends to improve in the first months
she has succeeded in the difficult migratory journey
and with reference to to the psychopathological
characteristics of the current clinical picture, all
symptoms can be referred to a “post traumatic stress
disorder” [309.81] rather than to the schizophrenia
The Integrated Group
operating at the Public Mental Health Center of Via
A. Di Giorgio of ASL Roma/ 1, sets up a small team
to work around this case. At first we meet Patricia
in the gynecologic ward of the Hospital, then in the
Soon the hospital
social worker tries to find out any detail about
Patricia’s relatives or friends, in Italy or in her
country, visiting the embassy and the Nigerian
community in Rome and in the refugee’s camp in
Crotone, without success.
After a first phase
of adaptation in the hospital, Patricia is moved to
the Villa Maria Pia clinic, linked with our group.
Here psychopharmaceuticals on high doses are
administered and Patricia reacts improving her
behaviour and her mental condition.
In collaboration with
the Social Worker Room (SOS) of Rome, she is
therefore transferred to a residence for migrants; a
few days later she assaults a guest trying to steal
her necklace. Once again she’s hospitalized to St.
Filippo's psychiatric ward, where her mood is
excited and she looks very delusional: it was
shocking to find a died little bird in her purse,
maybe related to her denied pregnancy.
From here, another
attempt to investigate her identity through police’s
record and fingerprints failes, because Patricia
unpredictably, runs away from the police station.
When two weeks later,
the outreach team of the Social Worker Room detects
her, back in the street, she agrees to go back to
the Clinic .
Nowadays and since
several months, thanks to a recovery extention,
Patricia is living in a Psychiatric Clinic, Villa
Letizia, devoted to chronic schizophrenic patients.
persisting the dissociative disorder, she still has
no memory at all and for us is impossible to
reconnect her with any contacts in her country or in
Next step in our
project is to appoint a support administrator, to
care for her rights and future in our country.
4. Operators and
Since the begining
the collaboration between hospital departments,
social services of the Municipality of Rome and our
group, dealing with homeless with mental desease,
has been very intense and effective.
In Italy in these
cases a network between institutions and services is
not set up and the autonomy and the "missions" of
each service prevents the possibility of coordinated
interventions, with a great waste of energy and
money and a big frustration of the involved
experienced in other cases handled by this group
over the years, a cooperation substained by a
network is effective in terms of results and does
not require any additional economic resources than
those provided for each service.
5. Possible proposals
Our team, even in
this difficult case, managed to get in touch and
collaborate with the various institutions which
should care, although facing a lack of financial
funds for daily expenses and clothing.
It is serious not to
have any cooperation with Embassies of the country
of origin, neither a specific reference perhaps at
the Interior Ministry or at the police station, in
order to achieve informations concerning the
identity and the paths that these subjects may have
had since arriving in Italy (contact points in
Lampedusa, Crotone or info about the people who may
have accompanied Patricia on her Italian
In such case we must
have an easy and fast access to personal information
through fingerprints , previous ID control, mug
shots, supported by police cooperation